The impact of coexisting Hashimoto's thyroiditis on the feasibility of endoscopic thyroidectomy in papillary thyroid carcinoma.

Objective: ：The safety of endoscopic thyroidectomy in patients with Hashimoto's thyroiditis (HT) is a matter of concern. This study aimed to assess the effect of concomitant HT on the feasibility of endoscopic thyroidectomy in patients with papillary thyroid carcinoma (PTC). Methods: This study is an observational, retrospective study. All patients were histopathologically diagnosed with HT. The study group consisted of 44 patients (40 %) with PTC who also had HT, whereas the remaining 66 patients (60%) without HT were assigned to the control group. The number of dissected lymph nodes, mean operation time, thyroid volume, blood loss, TSH level, and postoperative complications were recorded and statistically analysed. Results: One patient underwent conversion to open thyroidectomy because of recurrent laryngeal nerve (RLN) transection. Another patient required reoperation owing to postoperative haemorrhage. Statistically significant differences were observed in mean operation time (105.4 ± 10.7 vs 98.2 ± 7.4 min, P = 0.0001),mean thyroid lobe volume (12.2 ± 5.8 vs 9.6 ± 3.5 mL [mL], P = 0.0041), TSH level(4.1 ± 1.5 mIU/L vs 3.4 ± 0.9 mIU/L, P ＝ 0.0028), and the number of dissected lymph nodes between groups (4.1 ± 1.5 vs 3.4 ± 0.9,P = 0.0028). The estimated mean blood loss (31.5 ± 6.8 vs 29.5 ± 3.9 mL, P = 0.0529) and rate of complications (15.9% vs 10.6%, P = 0.4136) did not show statistically significant differences between groups. Conclusion: The coexistence of PTC and HT increases the operation time and difficulties in endoscopic thyroidectomy but does not affect postoperative outcomes. Endoscopic thyroidectomy can be safely performed with acceptable complication rates.

The association between artificial light at night and gestational diabetes mellitus: A prospective cohort study from China.

BACKGROUND: Emerging evidence suggests that exposure to outdoor artificial light at night (ALAN) may be associated with diabetes. However, limited research explores the relationship between outdoor ALAN and gestational diabetes mellitus (GDM). METHODS: We utilized data from a multilevel infant and early life cohort study conducted in Sichuan Province, China, between February 2018 and April 2021. A total of 9,120 participants were included in the final analysis. Outdoor ALAN exposure at participants' residential locations was estimated using time-varying satellite data, focusing on persistent night-time illumination at a scale of approximately 500x500m. The information about GDM was obtained from medical records. After adjusting for potential confounders, multivariable logistic regression models and restricted cubic splines were employed to estimate the association between ALAN exposure during pregnancy and GDM. RESULTS: Among the total recruitments, 1,484 (16.27%) women were diagnosed with GDM. Compared to women without GDM, those with GDM had a significantly higher mean outdoor ALAN exposure during pregnancy (18.98 nW/cm2/sr1 vs 24.28 nW/cm2/sr1, P < 0.001). Results from multivariable logistic models showed that higher outdoor ALAN exposure during pregnancy could increase the risk of GDM (OR (95% CI) 1st+2nd trimesters ALAN = 1.253 (1.157-1.356)). Meanwhile, results from the restricted cubic spline further indicated a non-linear association between outdoor ALAN exposure during pregnancy and GDM. Generally, with the radiance of the first two trimesters of ALAN increasing to about 17.9 nW/cm2/sr1, outdoor ALAN exposure became a risk factor for GDM. However, when the radiance of ALAN reached about 40.7 nW/cm2/sr1, the continued increasing OR estimation (OR (95% CI) = 1.489 (1.223-1.814)) of outdoor ALAN changed to steady. CONCLUSION: Our findings suggested that high levels of outdoor ALAN exposure during pregnancy can be associated with an increased risk of GDM, and a non-linear relationship pattern might exist. These findings substantially augment existing evidence, positing outdoor ALAN as an emergent, modifiable risk factor for GDM.

Outdoor artificial light at night and male sperm quality: A retrospective cohort study in China.

Due to the worldwide increased rate of infertility among reproductive-age couples, there is a growing interest in the relationship between environmental stimuli and human sperm quality. While animal studies have demonstrated the detrimental effects of outdoor artificial light at night (ALAN) on sperm quality, investigations based on human data are lacking. Therefore, we conducted a retrospective cohort study involving 1991 sperm donor candidates and employed multivariate linear regression and restricted cubic spline models to quantify the association between outdoor ALAN and sperm quality. The aim was to determine whether there exists an association between exposure to outdoor ALAN and sperm quality. The study included 1991 sperm donor candidates with the following characteristics: mean [SD] age, 24.98 [4.78] years; mean [SD] BMI, 22.13 [2.60] kg/m2; mean [SD] sleep duration, 7.66 [1.07] hours/day. Outdoor ALAN exposure of study participants ranged from 0 to 100 nW/cm2/sr. Multiple regression analysis on chronic exposure (0-90 days before sperm donation) and human sperm quality revealed the following associations: for CASA primary motion parameters, every 100-unit (nW/cm2/sr) increase in chronic outdoor ALAN was associated with a change of -0.043 [95%CI: 0.073, -0.014] in Linearity (LIN), and -5.523 [95%CI: 9.100, -1.946] in Curvilinear velocity (VCL). For CASA secondary motion parameters, every 100-unit (nW/cm2/sr) increase in chronic outdoor ALAN was associated with a change of -3.873 [95%CI: 4.926, -2.748] in non-progressive motility rate (NP). Furthermore, the primary sperm quality parameter exhibited a decline of -4.740 [95%CI: 8.853, -0.628] in sperm motility rate per 100-unit (nW/cm2/sr) increase in chronic outdoor ALAN. Similar associations were also observed for acute exposure (0-9 days before sperm donation). This retrospective study suggests that poorer sperm quality is more prevalent among adult males residing in areas with higher levels of outdoor ALAN, with a particularly pronounced impact observed in males below the age of 25 years.

Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage.

Importance: Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS. Objective: To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery. Design, Setting, and Participants: This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023. Exposures: Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms. Main Outcomes and Measures: The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters. Results: A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (ß = -0.40; 95% CI, -0.58 to -0.22), AC (ß = -1.97; 95% CI, -2.90 to -1.03), and EFW (ß = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions. Conclusions and Relevance: In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.

The mediation effect of vitamin A and vitamin D supplement in the association between serum vitamin K levels and musculoskeletal disorders in preschool children.

Introduction: Vitamin K deficiency may elevate the incidence of musculoskeletal disorders (MSD), whereas it lacks validation for pediatric populations and has uncertain dose recommendations. In this context, we hypothesized that serum vitamin K levels are associated with MSD in preschool children, and the widely used vitamin A and vitamin D supplements may mediate these associations based on potential mechanisms, which expects to provide guidance for future practice. Methods: A cross-sectional study was conducted in Sichuan province in southwestern China, from January 2021 to May 2022. Serum levels of vitamin K1/K2 and 25(OH)D were determined using the high-performance liquid chromatography method, and the diagnosis of MSD was executed by clinicians. Overall and stratified logistic regression analysis based on categorized 25(OH)D levels were conducted to assess association between serum vitamin K levels and MSD prevalence after adjusting for confounders. Mediation analysis was further performed and vitamin A and D supplementation was regressed as the mediator. Results: A total of 6,368 children aged 0-6 years old were enrolled. MSD was identified in 1179 (18.51%) of the children, while 5,189 (81.49%) of them did not present such disorder. After adjusting confounders, a significant difference was found in serum vitamin K1 level between children in MSD and Non-MSD group (OR = 0.802, 95%CI 0.745-0.864). No significant difference was found in serum vitamin K2 level between the two groups (OR = 0.975, 95%CI 0.753-1.261). The association between vitamin K1 level and MSD prevalence was partly (36.8%) mediated by vitamin A and D supplementation. Conclusions: A low serum vitamin K1 level is connected with an increased risk of MSD among children, highlighting that vitamin A and D supplementation is a helpful intervention to prevent MSD in children with vitamin K deficiency.

Analysis of variation in pre-procedural fasting duration for common inpatient gastrointestinal procedures.

Background: Gastrointestinal procedures generally require pre-procedural fasting to optimize sedation safety. While the American Society of Anesthesiologists (ASA) recommends no intake of clear liquids and solid food 2-4 and 6-8 hours respectively prior to endoscopic procedures, the actual nil per os (NPO) duration for these procedures in practice is unknown. Our objective was to analyze NPO duration for patients undergoing these procedures and to determine its association with clinical and administrative variables. Methods: Inpatient data from 2016-2018 for the three procedures was extracted from electronic medical records and administrative data at a single-center tertiary academic medical center. Various statistical tests (Kruskal-Wallis, Wilcoxon, Pearson) were employed depending on the outcome type and data distribution. Results: One thousand three hundred and twenty-five esophagogastroduodenoscopies (EGDs), 753 colonoscopies, and 550 endoscopic retrograde cholangiopancreatographies (ERCPs) were included. The median NPO time for all procedures was 12.6 hours (IQR, 9.6-16.1 hours). The median NPO times were 12.6, 11.9, and 13.1 hours for EGD, colonoscopy, and ERCP respectively. NPO duration was greater for Hispanic than non-Hispanic patients (median 13.9 vs. 12.4, P=0.018). NPO duration was also associated with increased age (r=0.041, P=0.027) and inversely related to hospital occupancy (r=-0.08, P<0.0001). There were no statistically significant associations with provider type, hospital location or service, length of stay, and total number of comorbidities. Conclusions: NPO times for common inpatient gastroenterology (GI) procedures generally exceeded 12 hours, suggesting there is an opportunity to adopt changes to decrease NPO duration for low-risk patients while maintaining adherence to guidelines and best practice.

Multi-Target Multi-Camera Tracking of Vehicles Using Metadata-Aided Re-ID and Trajectory-Based Camera Link Model.

In this paper, we propose a novel framework for multi-target multi-camera tracking (MTMCT) of vehicles based on metadata-aided re-identification (MA-ReID) and the trajectory-based camera link model (TCLM). Given a video sequence and the corresponding frame-by-frame vehicle detections, we first address the isolated tracklets issue from single camera tracking (SCT) by the proposed traffic-aware single-camera tracking (TSCT). Then, after automatically constructing the TCLM, we solve MTMCT by the MA-ReID. The TCLM is generated from camera topological configuration to obtain the spatial and temporal information to improve the performance of MTMCT by reducing the candidate search of ReID. We also use the temporal attention model to create more discriminative embeddings of trajectories from each camera to achieve robust distance measures for vehicle ReID. Moreover, we train a metadata classifier for MTMCT to obtain the metadata feature, which is concatenated with the temporal attention based embeddings. Finally, the TCLM and hierarchical clustering are jointly applied for global ID assignment. The proposed method is evaluated on the CityFlow dataset, achieving IDF1 76.77%, which outperforms the state-of-the-art MTMCT methods.

SOCS2 Inhibits Mitochondrial Fatty Acid Oxidation via Suppressing LepR/JAK2/AMPK Signaling Pathway in Mouse Adipocytes.

Suppressor of cytokine signaling 2 (SOCS2) plays an important role in fat deposition, skeletal muscle, central nervous system development, and mitochondria biogenesis. Nevertheless, the regulatory mechanisms of SOCS2 on mitochondrial fatty acid oxidation (FAO) remain unclear. Leptin could inhibit food intake and increase thermogenesis through leptin receptor (LepR), which was present in the hypothalamus and certain peripheral organs, including adipose tissue. With strong interest, we focused on the connection between leptin and SOCS2 and their effect on FAO in adipocytes. In our study, we found that the mRNA level of SOCS2 and the protein levels of PGC-1α, CPT-1b, FAT, and p-ACC were elevated by leptin in the inguinal adipose tissue of mice. On the contrary, the protein levels of FABP4, FATP1, and FAS were declined. The genes related to fatty acid oxidation such as PGC-1α, NRF-1, TFAM, CPT-1b, AOX1, COX2, and UCP2 were attenuated by SOCS2, but elevated by leptin. Moreover, fatty acid oxidation enzyme MCAD, LCAD, and Cyt C levels were reduced in response to SOCS2. These reductions correspond well with the reduced release of free fatty acid and the reduction of mitochondrial complexes I and III by SOCS2. Furthermore, JAK2/AMPK pathway-specific inhibitors could block the mitochondrial FAO; hence, this pathway was implied to have a potential impact on FAO. Together, these studies suggested that SOCS2 had a negative effect on mitochondrial fatty acid oxidation, and the LepR/JAK2/AMPK pathway played a crucial role in this process.

Mark4 Inhibited the Browning of White Adipose Tissue by Promoting Adipocytes Autophagy in Mice.

Autophagy can remove excess or dysfunctional proteins and organelles to maintain cellular homeostasis. Browning of white adipose tissue increases the energy expenditure. Microtubules affinity regulated kinase 4 (Mark4) can regulate a variety of physiological processes. According to previous studies, we speculated that Mark4-autophagy-browning of white adipose tissue had certain linkages. Here, we established two autophagy models through serum starvation and rapamycin treatment and detected that the overexpression of Mark4 increased the expression of autophagy-related factors Beclin1, ATG7, and significantly decreased the autophagy substrate P62. Further tests showed that the overexpression of Mark4 promoted the conversion of autophagy marker protein LC3A to LC3B-II by activating the AMP-activated protein kinase (AMPK) pathway and inhibition of the AKT/mTOR signaling. Moreover, Mark4 decreased the expression of thermogenesis genes via promoting autophagy. These results indicated that Mark4 inhibited the browning of white adipose tissue via promoting autophagy.

Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management.

OBJECTIVE: Timely availability of intravenous infusion pumps is critical for high-quality care delivery. Pumps are shared among hospital units, often without central management of their distribution. This study seeks to characterize unit-to-unit pump sharing and its impact on shortages, and to evaluate a system-control tool that balances inventory across all care areas, enabling increased availability of pumps. MATERIALS AND METHODS: A retrospective study of 3832 pumps moving in a network of 5292 radiofrequency and infrared sensors from January to November 2017 at The Johns Hopkins Hospital in Baltimore, Maryland. We used network analysis to determine whether pump inventory in one unit was associated with inventory fluctuations in others. We used a quasi-experimental design and segmented regressions to evaluate the effect of the system-control tool on enabling safe inventory levels in all care areas. RESULTS: We found 93 care areas connected through 67,111 pump transactions and 4 discernible clusters of pump sharing. Up to 17% (95% confidence interval, 7%-27%) of a unit's pump inventory was explained by the inventory of other units within its cluster. The network analysis supported design and deployment of a hospital-wide inventory balancing system, which resulted in a 44% (95% confidence interval, 36%-53%) increase in the number of care areas above safe inventory levels. CONCLUSIONS: Network phenomena are essential inputs to hospital equipment fleet management. Consequently, benefits of improved inventory management in strategic unit(s) are capable of spreading safer inventory levels throughout the hospital.

ColXV Aggravates Adipocyte Apoptosis by Facilitating Abnormal Extracellular Matrix Remodeling in Mice.

The extracellular matrix (ECM) is a highly dynamic structural network and plays an essential role in cell behavior and regulation during metabolic homeostasis and obesity progression. Abnormal ECM remodeling impairs adipocyte plasticity required for diverse cellular functions. Collagen XV (ColXV) is a proteoglycan localized to the outermost layer of basement membranes (BMs) and forms a bridge between the BMs and the fibrillar collagen matrix. Nevertheless, how ColXV affects ECM composition and the reason for subsequent adipocyte apoptosis is still unclear. This report found, through RNA-seq data, that ColXV is linked to cell growth and ECM remodeling. Findings show that, in response to excessive expression of extracellular ColXV, the AMPK/mTORC1 pathway is strongly activated and triggers a cascade of mitochondrial apoptosis. This is the first study to make use of ECM three-dimensional reconstruction, based on decellularization in the adipose tissues and the study reveals that ColXV is an activation factor that alters ECM remodeling in adipose tissues. It was also demonstrated that the fibroblast growth factor 2 (FGF2)/fibroblast growth factor receptor 1 (FGFR1) axis involved in ECM remodeling is suppressed by ColXV due to reduction of FGF2 translocation to FGFR1. Furthermore, ColXV induced remodeling of ECM preceding apoptosis and continued to induce apoptosis in adipocytes. Collectively, our findings establish ColXV as a basement membrane collagen with homology to ColXVIII, indicating that it is one of the positive regulators for inducing ECM remodeling and further promoting adipocyte apoptosis.

Estimating Missing Unit Process Data in Life Cycle Assessment Using a Similarity-Based Approach.

In life cycle assessment (LCA), collecting unit process data from the empirical sources (i.e., meter readings, operation logs/journals) is often costly and time-consuming. We propose a new computational approach to estimate missing unit process data solely relying on limited known data based on a similarity-based link prediction method. The intuition is that similar processes in a unit process network tend to have similar material/energy inputs and waste/emission outputs. We use the ecoinvent 3.1 unit process data sets to test our method in four steps: (1) dividing the data sets into a training set and a test set; (2) randomly removing certain numbers of data in the test set indicated as missing; (3) using similarity-weighted means of various numbers of most similar processes in the training set to estimate the missing data in the test set; and (4) comparing estimated data with the original values to determine the performance of the estimation. The results show that missing data can be accurately estimated when less than 5% data are missing in one process. The estimation performance decreases as the percentage of missing data increases. This study provides a new approach to compile unit process data and demonstrates a promising potential of using computational approaches for LCA data compilation.